Basic Information
| Provider Information | |||||||||
| NPI: | 1124183025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUBIS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10557 HALL MEADOW RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921313640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586890998 | ||||||||
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| Practice Location | |||||||||
| Address1: | 34520 BOB WILSON DRIVE | ||||||||
| Address2: | NAVAL MEDICAL CENTER OPHTHALMOLOGY SUITE 202 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195326719 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2006 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | G74803 | CA | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.